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LEUKEMIA Dr MOKARIAN ICM 83/2/15

LEUKEMIA Dr MOKARIAN ICM 83/2/15. LEUKEMIA CLONAL DISORDER 8-10 /100.000 PATHOGENESIS: UNKNOWN. LEUKEMIA CHRONIC ACUTE CML CLL AML ALL

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LEUKEMIA Dr MOKARIAN ICM 83/2/15

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  1. LEUKEMIA Dr MOKARIAN ICM 83/2/15

  2. LEUKEMIA CLONAL DISORDER 8-10 /100.000 PATHOGENESIS: UNKNOWN

  3. LEUKEMIA CHRONIC ACUTE CML CLL AML ALL ADULT ADULT 90% OF ADULT 10% OF ADULT 10%OF CHILD 90%OF CHILD

  4. LEUKEMIA APPROUCH TO LEUKOCYTOSIS MATURE MATURE IMMATURE IMMATUR MYLOID LYMPHOID MYLOID LYMPHOID LEUKEMOID CML AML ALL REACTION LEUKOMOID RECTION CLL

  5. LEUKEMIA • SYMPTOM & SIG • OF ANEMIA • OF THROMBOCYTOPENIA • OF LEUKOPENIA • OF BON MARROW EXPANTION • OF ORGAN DEPOSITION • OF INCREASED WBC • OF ELECTOROLITE DERANGMENT

  6. LEUKEMIA APROUCH TO LEKOCYTOSIS MIC METHOD LIGHT MICROSCOPY IMMUNOHISTOCHEMISTRY CYTOGENETIC FLOCYTOMETRY HISTOCHIMISTRY

  7. H history from patient with leukemia • Increasing fatigue or decreased exercise tolerance (anemia) • Excess bleeding or bleeding from unusual sites (DIC, thrombocytopenia) • Fevers or recurrent infections (granulocytopenia) • Headache, vision changes, nonfocal neurologic abnormalities (CNS leukemia or bleed) • Early satiety (splenomegaly) • Family history of AML (Fanconi, Bloom or Kostmann syndromes or ataxia telangiectasia) • History of cancer (exposure to alkylating agents, radiation, topoisomerase II inhibitors) • Occupational exposures (radiation, benzene, petroleum products, paint, smoking, pesticides

  8. physical Examination • Performance status (prognostic factor) • Ecchymosis and oozing from IV sites (DIC, possible acute promyelocytic leukemia) • Fever and tachycardia (signs of infection) • Papilledema, retinal infiltrates, cranial nerve abnormalities (CNS leukemia) • Poor dentition, dental abscesses • Gum hypertrophy (leukemic infiltration)(M4) • Skin infiltration or nodules (leukemia infiltration)(M4) • Lymphadenopathy, splenomegaly, hepatosplenomegaly • Back pain, lower extremity weakness [spinal granulocytic sarcoma, most likely in t(8;21) patients]

  9. CHRONIC MYELOGENOUS LEUKEMIA

  10. CHRONIC MYELOGENOUS LEUKEMIA • PATHOGENESIS: • PHILADELPHIA CHROMOSOM • ABL / BCR GENE • THYROSIN KINASE ETHIOLOGY : UNKNOWN

  11. CHRONIC MYELOGENOUS LEUKEMIA • PRESENTATION • SYMPTOME • SIGN • PHASE OF DISEASE • CHRONIC PHASE • ACCELERATED PHASE • BLASTIC PHASE DIAGNOSIS

  12. CHRONIC MYELOGENOUS LEUKEMIA • TREATMENT : • HYDROXYURAE • INTERFERON • BONE MARROWWWW TRANSPLANTATION • GLIVEC • SUPORTIVE CARE

  13. CML

  14. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

  15. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) CLINICAL FINDING ASYMPTOMATIC40% SYMPTOMATIC FATIGUE BLEEDIN TENDENCY ILLBEING F8 DEF FEVER VWF DEF LAP THROMBOCYTOPENIA HEPATOSPLENOMEGALLY AUTOIMMUN MANIFISTATION STERNANAL TENDERNESS ABDOMINAL MASS SKIN INFILTERATION INFILTERATION OF TONSILS INFILTERATION OF ORGAN DR F MOKARIAN

  16. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) INTERNATIONAL CLL WORKSHOP DIAGNOSTIC CRITERIA: 1- LYM> = 10000 2-BMA LYM > = 30% A= 1 + 2 OR 3 3- MONOCLONAL B- CELL B= 2+3 NCI-SPONSORED CLL WORKING GROUPED 1- LYM> 5000 + LESS 55% ATYPICAL LYM + B-CELLMARKER + CD5 ( CD19 CD20 CD24 ) 2- MARROW LYM>30% DR F MOKARIAN

  17. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) DIFFERENTIAL DIAGNOSIS: INFECTION CAUSESMALIGNANT CAUSES BACTERIAL ( eg TB) B CELL VIRAL ( IM) PLL HYPERREACTIVE MALARIA NHL SPLENOMEG(HMS) HCL T CEL PLL NHL HCL LGL L DR F MOKARIAN

  18. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) PRETREATMEN INVESTIGATION CBC PBS RET COOMB’S TEST LDH LFT KFT SPEP IEP B2 MICROGLOBULIN IMMUNOPHENOTYPING BMA CYTOGENETIC ANALYSIS DR F MOKARIAN

  19. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) RAI CLASSIFICATION STAGE MODIF STAGE DESCRIPTION MS (YR) 0 LOW RISK LYM >10 1 INTERMED RISK LYM+ LAP >8 2 INTERMED RISK LYM + SPL+/-LAP 6 3 HIGH RISK LYM +ANEM+/- LAP OR SPL 2 4 HIGH RISK LYM +THROM 2 +/- ANEM +/- SPL +/- LAP LYM > 5000 >4WEAK HB<11 PLT< 100000 DR F MOKARIAN

  20. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) BINET CLASSIFICATION FOR CLL INVOLVED MS SRAGE BLOOD COUNTS AREA (YRS) A HB>10 <3 >10 PLT>100000 B HB>10 >3 7 PLT>100000 C HB<10 ANY NUMBER 2 PLT< 100000 FIVE AREA OF INVOLVEMENT: H&N AXILLA GROINS SPLEEN HEPATOMEG DR F MOKARIAN

  21. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) SUMMARY OF TREATMENT: INDICATION OF CCR CHLORAMBUCIL OR FLUDARABIN PREDNISOLON RADIOTHERAPY SPLENECTOMY GAMMAGLOBULIN DR F MOKARIAN

  22. CHRONIC LYMPHOCYTIC LEUKEMIA(CLL) • MARKERS OF POOR PROGNOSIS IN CLL: • ADVANCE STAGE • DOUBLING TIME <12 M • DIF MARROW INVOL • PROLYM OR CLEAVED CELL INCREASED • POOR RESPONSE TO CCR • HIGH B2 MG LEVEL • ABNORMAL CARYOTYPE • P53 MUTATION DR F MOKARIAN

  23. CLL

  24. ACUTE MYELOGENOUS LEUKEMIA • CLASIFICATION • LEUKOSTASIS • DIAGNOSIS • TREATMENT • SUPORTIVE CARE • CHEMOERAPY • INDUCTION OF REMMISION • CONSULIDATION • MAINTENANCE

  25. Acute Myeloid Leukemia (AML) Classification Systems French-American-British (FAB) Classification M0: Minimally differentiated leukemia M1: Myeloblastic leukemia without maturation M2: Myeloblastic leukemia with maturation M3: Hypergranular promyelocytic leukemia M4Eo: Variant: Increase in abnormal marrow eosinophils M4: Myelomonocytic leukemia M5: Monocytic leukemia M6: Erythroleukemia (DiGuglielmo's disease) M7: Megakaryoblastic leukemia

  26. World Health Organization Classificationb • I. AML with recurrent cytogenetic translocations • AML with t(8;21)(q22;q22);AML1(CBFa)/ETO • Acute promyelocytic leukemia [AML with t(15;17)(q22;q12) and variants; PML/RARa] • AML with abnormal bone marrow eosinophils [inv(16)(p13q22) or t(16;16)(p13;q22) CBFb/MYH1] • AML with 11q23 (MLL) abnormalities • II. AML with multilineage dysplasia • With prior myelodysplastic syndrome • Without prior myelodysplastic syndrome • III. AML and myelodysplastic syndrome, therapy-related • Alkylating agent-related • Epipodophyllotoxin-related • Other types • IV. AML not otherwise categorized • AML minimally differentiated • AML without maturation • AML with maturation

  27. AML

  28. AML AUER ROD

  29. ACUTE LYMPHOBLASTIC LEUKEMIA • CLASIFICATION • LEUKOSTASIS • DIAGNOSIS • TREATMENT • SUPORTIVE CARE • CHEMOERAPY • INDUCTION OF REMMISION • CONSULIDATION • MAINTENANCE

  30. ALL

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